Abstract
BACKGROUND AND AIMS: Disordered eating behaviors (DEBs) in adolescence are influenced by family structure and dynamics, including parental supervision, emotional support, and exposure to neglect or abuse. This study examined the associations between adolescents' relationships with parents or guardians, including indicators of neglect and abuse, and the prevalence of DEBs. METHODS: This cross-sectional study assessed DEBs and family relationship indicators, including the frequency of shared meals, parental awareness of adolescents' free-time activities, emotional understanding, and experiences of physical or sexual assault. Data were obtained from the 2019 National School-Based Health Survey, a representative sample of 95,367 Brazilian students aged 13-17 years. Poisson regression models estimated adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs), stratified by sex. RESULTS: Fully adjusted analyses revealed that girls were significantly more likely to report DEBs when living with neither parent (PR = 1.34; 95% CI: 1.03-1.75) or never having family meals (PR = 2.36; 95% CI: 1.96-2.84). DEBs were more prevalent in both sexes when their parents did not supervise their school attendance or were unaware of their free-time activities and when their parents provided limited emotional support. Furthermore, reporting experiencing parental physical aggression or sexual abuse within the past year was also associated with a higher prevalence of DEBs (p-value < 0.05). CONCLUSIONS: The findings suggest that parental neglect is associated with an increased likelihood of DEBs in adolescents and that experiences of parental aggression and sexual abuse may further compound this potential risk. These results underscore the importance of family-based prevention strategies in addressing adolescent eating disorders.